Dr Krishnaveni Nayini

Conditions Obstetrics and Gynaecology

Polycystic ovarian syndrome (PCOS) is very commonly associated with women of reproductive age group. As per the data of multiple research studies in India, it has been found to be prevalent in 6 to 20% of the women population, of which, the prevalence is higher in women of the urban region and, in young-adults. Women with this condition can face multiple gynaecological issues ranging from irregular periods to inability to conceive.

PCOS leads to the appearance of lots of tiny fluid-filled sacs in your ovaries. Women with PCOS often report of irregular menstrual cycle, fertility problems, and symptoms such as excessive hair growth in unwanted areas of the body due to increase in the level of male hormones. By the early identification and treatment PCOS can be treated and its symptoms can be alleviated.

What Causes Polycystic Ovaries?

There is no exact cause for PCOS, it can occur due to multiple factors. But some important reasons that can play a role in its development include resistance to insulin, obesity, and hereditary. Due to an interplay of various such factors, ovulation doesn’t occur normally in women with PCOS. The ovaries in such a condition thus become cystic with multiple small immature ova. An imbalance in female hormones, along with an increase in male hormones or androgens also occurs in PCOS.

Symptoms of Polycystic Ovaries

The symptoms of polycystic ovaries usually first appear when you are in your late teens or early twenties. Possible effects of polycystic ovaries include:

  • Irregular periods or your period stopping completely
  • Difficult getting pregnant as your ovaries are unable to release eggs each month
  • Excessive hair growth on the face and body, which is linked to the higher levels of male hormones.
  • Thinner hair
  • Oily or spotty skin
  • Women with PCOS may also be at higher risk of developing problems such as type 2 diabetes.

What to expect when you visit a gynaecologist?

A detailed physical check-up, ultrasound, and blood tests are often required to make a diagnosis of PCOS.

The treatment for PCOS is mostly medicinal but in some cases, surgeries can also be required to restore ovulation. Intervention through laproscopic procedures or LASERs are less invasive and available as treatment options. Women are advised to keep a check on their weight and stay physically fit, which helps in preventing and reducing its severity. Since early identification reduces the risk of long-term complications, it is advisable for women to meet their gynaecologist at the earliest in case of any doubt of PCOS.

No matter how severe the disease be, the good news is that women with PCOS can still conceive normally with no complications once they get the right treatment. If you have any symptoms which can point out to PCOS, then visit your gynaecologist today.

Menopause is usually diagnosed in women over the age of 45 years, who have not had a period for more than a year. Any bleeding or spotting from the vagina after this year is post-menopausal bleeding and needs to be checked by your healthcare provider.

Bleeding after menopause is usually a sign of a minor health problem but can sometimes be an early sign of a more serious disease.

If detected early any underlying condition small or big can be treated successfully.

What can it look like?

Post-menopausal bleeding can range from light spotting that is pinkish-gray or brown, or it can be a heavy flow like in regular periods. Most of the time there is no pain associated with this bleeding. 

What can cause it?

The most common causes of post-menopausal bleeding can be:

- Inflammation or thinning of the vaginal or womb lining

-Non-cancerous polyps in the cervix or uterus

-Endometrial hyperplasia (thickened womb lining)

In some cases, post-menopausal bleeding can also be caused by cancer, such as ovarian or womb cancer.

The treatment for post-menopausal bleeding varies as per the cause, and in any cause, early diagnosis is the best way to assure successful treatment outcomes.

Menstrual periods with abnormally heavy or prolonged bleeding are termed menorrhagia. Though many women may experience a heavy flow of blood during their periods, not all may fit into the category of menorrhagia. If you are experiencing heavy periods then consult your gynaecologist in order to know the cause for it. Early identification of cause can prevent complications.

Symptoms of Menorrhagia

It may be difficult to tell whether your periods are heavier than usual. Some symptoms that point towards heavy menstrual flow include:

  • Soaking through one or more sanitary pads every hour for several hours
  • Need of double sanitary protection to control blood flow
  • Waking up at night for a need to change the sanitary pad
  • Bleeding persisting for more than a week
  • Restricted daily activities due to menstrual blood flow
  • Loosing around 1/3rd of a cup of menstrual blood per cycle for two cycles

What Causes Menorrhagia?

Heavy periods can occur due to various reasons. Some causes for heavy periods include:

  • Hormonal imbalance- Any imbalance between female hormones, estrogen and progesterone can lead to heavy periods. Such an imbalance can be seen in women with PCOS, thyroid disorders, obesity etc.
  • Polycystic ovaries
  • Pelvic infection
  • Uterine Fibroids
  • Endometriosis
  • Intrauterine devices
  • Bleeding disorders
  • Female cancers

At times consumption of some medicines can also be a cause for heavy periods.

Diagnosis of Menorrhagia

Your will be asked about your medical history and menstrual cycles first. Additionally, a detailed physical examination and one or more tests or procedures may be needed to form a diagnosis for heavy periods. Some tests that you may be advised can include:

  • Blood tests: For iron deficiency and other conditions, such as thyroid disorders or blood-clotting abnormalities.
  • Pap test: In this test, cells from your cervix are collected and tested for infection, inflammation or any abnormal changes.
  • Endometrial biopsy: A sample of tissue from the inside of your uterus can be taken to be examined by a pathologist.
  • Ultrasound: For the visualisation of the uterus, ovaries and pelvis.
  • Hysteroscopy: This exam involves using a lighted instrument to see the inside of your uterus.

Treatment of Menorrhagia

Menorrhagia can be treated with medicines or may require surgical intervention depending on the cause of it.

Fibroids are non-cancerous benign tumours that grow within the uterus. Fibroids are common and affect one in five women during their childbearing age. By the age of fifty half of women have fibroids.

They can be very small in size, and need a microscope to be detected or can be huge and weigh several pounds.

Where can Fibroids form?

They can grow in various portions of the uterus including: 

-The muscular wall of the uterus

-Under the lining of the uterus

-Outside the lining of the uterus

What are the symptoms of Fibroids?

Depending on their size and the portion of the uterus they are growing they can cause various symptoms. In some women they may not cause any symptoms and may be discovered accidentally during an ultrasound or a pelvic examination, however in others they may lead to symptoms such as:

  • Heavy periods as described above including blood clots
  • Periods that last longer than a week
  • Need to urinate more frequently
  • Painful periods
  • A feeling of fullness in the lower abdomen
  • Backache or leg pains

Fibroids contribute to heavy menstrual flow, by applying pressure on the uterine wall, hindering normal contraction of the uterus, stimulating the growth of blood vessels, or by causing hormonal imbalance. Very rarely a fibroid may also cause acute pain. This can be in a case when it outgrows its blood supply.

Why do Fibroids develop?

The exact reason for the development of fibroids is not known, but most of them can be linked to hormones or genes. Fibroids develop mostly in reproductive women when their oestrogen levels are the highest. This is the reason why they may shrink as the woman reaches her menopause, and her monthly periods stop. In some women, fibroids may also develop due to more growth factors or extracellular matrix material which makes them overgrow. 

Diagnosis and Treatment of Fibroids

Fibroids can be diagnosed upon pelvic examination by your gynaecologist, who may also advise for an ultrasound to confirm the diagnosis. At times, other tests such as MRI, hysteroscopy, or biopsy of the uterine lining may be done for a detailed study of fibroids.

For treating fibroids various modes of treatments may depend upon, the severity of symptoms, age, and whether the woman with fibroids wants to get pregnant in the future or not. The treatments may range from medications to surgery. In some cases, hysterectomy or complete removal of the uterus through conventional surgery or laparoscopy may be done to get rid of fibroids completely.

What you can do to prevent the development of fibroids?

Though due to the genetic and hormonal association that fibroids have, they cannot be completely prevented. But some lifestyles changes can reduce your risk of getting them. Regular exercise is recommended for all women, which helps control weight and in turn keeps the hormones in balance. Eating fresh fruits and vegetables helps maintain a healthy lifestyle.

When to meet your gynaecologist for fibroids?

It is recommended, that in case of heavy bleeding, feeling of fullness in the lower abdomen, or having excessive menstrual cramps one meets their gynaecologist. Besides, regular gynaecological check-ups are recommended which can help one get aware of developing fibroids at an early stage.

Endometriosis is a painful condition in which tissues similar to the one that lines the inside of the uterus, grows outside the uterus. With early diagnosis and right treatment, the symptoms of endometriosis can be relieved and potential complications can be prevented.

What Causes Endometriosis?

The exact cause of endometriosis is still unknown. Some causes which are suggestive include:

  • During menstruation, some of the tissue backs up through the fallopian tubes into the abdomen - reverse menstruation, where it attaches and grows.
  • Endometrial tissue may travel and implant to the outside of uterus via blood or lymphatic channels.
  • Cells in any location may transform into endometrial cells.
  • Immune system disorders may lead to endometriosis at times. In such a case the body may be unable to identify and destroy the unwanted growth of cells.
  • Certain families may also have predisposing genetic factors to the disease.

Symptoms of Endometriosis

The symptoms of endometriosis can vary depending on which parts of the body are affected and how much endometrial tissue has formed. Some women only have mild symptoms, but endometriosis can have a significant impact on your life. Some symptoms of endometriosis include:

  • Pain, especially excessive menstrual cramps that may be felt in the abdomen or lower back
  • Painful intercourse
  • Abnormal or heavy menstrual flow
  • Infertility
  • Painful bowel movements and urination during menstrual periods
  • Gastrointestinal problems, such as diarrhoea, constipation and/or nausea

Pain experienced during endometriosis may not be related to the severity of disease.

If you are experiencing any of the symptoms as mentioned above then meet your gynaecologist.

Diagnosis of Endometriosis

  • Diagnosis begins with a gynecologist evaluating a patient’s medical history and completing a physical examination, including a pelvic exam.
  • Diagnosis of endometriosis can only be confirmed, when the doctor performs a laparoscopy, and biopsy of any suspicious tissue taken from the areas of tissue growth. Laparoscopy is a minor surgical procedure in which a laparoscope, a thin tube with a camera at the end, is inserted into the abdomen through a small incision. Laparoscopy is also used to determine the location, extent and size of the endometrial growths.
  • Imaging such as ultrasound, CT scan and MRI scan may also be needed at times to make a diagnosis.

Treatment of Endometriosis

It is important to see a doctor if you think that you might have endometriosis as it can have a major impact on the quality of your life. The treatment required will vary as per the extent of your disease and can include:

  • Pain medication to ease out your cramps
  • Hormone therapy to alleviate symptoms and restrict the progression of disease
  • Conservative surgery to remove the diseased part laparoscopically or conventionally, in women who are trying to get pregnant

Complete hysterectomy with removal of ovaries

Infertility is not being able to get pregnant despite having frequent, unprotected sex for at least a year. If you and your partner are struggling to have a baby, then you are not alone, infertility affects 15% couples worldwide.

What causes infertility?

Infertility can affect both the male and the female partner. Some causes of female infertility can be:

  • Ovulation disorders - These can affect the release of eggs from the ovaries. Such disorders can be caused due to hormonal issues, eating disorders, tumours or unregulated excessive exercise.
  • Uterine or cervical abnormalities, including endometriosis
  • Abnormality or blockade of the fallopian tube (tube which carries the ovum to the uterus)
  • Early menopause - At times ovaries may stop working and menstruation may stop before the woman hits 40, leading to infertility.

Other causes of infertility in a woman can include pelvic adhesions and cancers.

When should you meet a doctor?

If you have not been able to conceive for one year despite frequent unprotected sex then you should talk to your doctor about it. However, meet your doctor earlier in case:

-Your age is 35 or above and you have been trying to conceive for more than 6 months

-You are over 40 years of age

-Your periods are irregular or absent

-Your periods are very painful

-You have been diagnosed with any uterine or pelvic problems

-You have had multiple miscarriages in the past

-You have PCOS

-You have any other known fertility issue